Businesses and nearly all their health coverage plans embrace disease management (DM) programs to reduce medical costs and help individuals manage their health. While some of these programs can save money, the evidence of their economic impact is scant, according to a new study from Cornell University and Thomson Medstat.

In a review of 44 studies analysing the economic impact and return on investment (ROI) for DM programs, researchers found mixed results for programs targeting depression, diabetes and asthma but positive ROI for programs targeting congestive heart failure or multiple illnesses.

The study's lead author is Ron Z. Goetzel, director of the Institute for Health and Productivity Studies (IHPS) at Cornell: "Overall, there has been little scientifically rigorous research conducted to determine the financial impact of DM programs." The DM industry's revenues jumped to more than $600 million in 2002 from $85 million in 1997.

The cost of DM programs for congestive heart failure averaged about $1,400 per participant, and savings averaged almost $3,900. The average ROI, achieved in a little less than a year, was $2.78 in savings for every dollar spent. Four of the five studies that used the optimal research design produced a positive ROI.

Many of the studies that looked at DM programs for asthma showed savings, but only two of the better-designed studies delivered enough savings to produce a positive ROI, and these studies covered very few cases.

The results for diabetes were too variable to provide conclusions, Goetzel said. Among programs managing patients with multiple diseases, the ROI ranged from about $4 to almost $11 in savings for every dollar spent over an average of 1.4 years.

DM programs targeting depression consistently cost more - about $500 more a year - than they saved in direct medical costs. "On the other hand," Goetzel said, "these programs may deliver a positive ROI if we factor in the impact on patients' day-to-day functioning, absenteeism and overall productivity."